Collaborative Specialty Care for Gulf War Illness

海湾战争疾病的协作专业护理

• 批准号: 9926647
• 负责人: Lisa Marie McAndrew
• 金额: --
• 依托单位: VA NEW JERSEY HEALTH CARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2020
• 资助国家: 美国
• 起止时间: 2020-06-01 至 2024-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9926647
• 关键词: Academy; Address; Advisory Committees; Analgesics; British; Caring; Clinic; Clinical Trials; Competence; Complex; Consult; Consultations; Data; Education; Effectiveness; Ensure; Future; Geographic Locations; Goals; Guidelines; Gulf War; Health; Health system; Hybrids; Information Dissemination; Injury; Interview; Knowledge; Lead; Measures; Medicine; Mental Depression; Methods; Modeling; Outcome; Pain; Parkinson Disease; Patient Care; Patient Self-Report; Patients; Pharmacologic Substance; Primary Health Care; Problem Solving; Provider; Quality of Care; Randomized; Recommendation; Request for Applications; Resources; Site; Specialist; Strategic Planning; Symptoms; Translating; Translational Research; Veterans; War; Work; barrier to care; base; care providers; chronic pain; collaborative care; disability; effective therapy; effectiveness implementation trial; health care model; implementation research; improved; interest; medical specialties; operation; physical symptom; relative effectiveness; research to practice; satisfaction; skills; telehealth

There is a quality chasm between the care Gulf War Veterans (GWVs) should receive and the care they do receive. Our data show 70% of GWVs with Gulf War Illness (GWI) do not receive treatment recommendations for their GWI and 78% are NOT very satisfied with their care. Reducing this quality chasm is essential. The VA and DoD have invested hundreds of millions of dollars to develop new treatments, including the second largest clinical trial for GWVs which is finding health coaching and problem-solving treatment both reduce the disability of GWI. Without effective models of healthcare to implement these treatments, GWVs will not benefit. In the current model of care, GWVs receive care locally through VA’s primary care patient aligned care teams (PACTs). The VA War Related Illness and Injury Study Center (WRIISC) supports the current model of care by increasing local knowledge of the skills and treatments needed to manage GWI through national education efforts and electronic consultation (e-consultation) on difficult cases. The WRIISC and other stakeholders are currently questioning whether improving local knowledge of skills and treatments for GWI is enough to address the quality chasm, or if GWI is too complex to be treated in primary care without additional support from specialists in GWI. A potentially useful model of care for GWI is collaborative specialty care where specialists work with PACTs to synergistically treat patients. The local PACT is the lead of the team with the specialist providing some direct care to the patient (through tele-health) and also consulting with the PACT about other aspects of care. Collaborative specialty care is effective for other complex conditions (e.g., depression) with over 40 studies documenting its efficacy. The goal of this proposal is to conduct a hybrid type 1 randomized effectiveness/implementation trial for GWVs with GWI (n=220). Our primary aim is to determine the effectiveness of tele-CSC as compared to e-consultation. In tele-CSC, our specialty provider team will deliver health coaching and problem-solving treatment to GWVs and recommend the PACT make monthly optimization of analgesics. In e-consultation the specialty provider team will make a onetime recommendation to the PACT that the GWV locally receive health coaching and problem-solving treatment and analgesic optimization. Our secondary aim is to understand implementation outcomes. This information will be used to guide a future randomized (by VISN) multi-site implementation study. Throughout, an advisory committee of operations partners will be convened to ensure that the results of the study are able to directly and immediately improve care. Determining the best model of care to translate research into practice for GWVs with GWI is a key goal of the VA Gulf War Strategic Plan and a specific aim of this Request for Applications.

海湾战争退伍军人 (GWV) 应获得的护理与他们实际执行的护理之间存在质量差距 收到。我们的数据显示，70% 患有海湾战争病 (GWI) 的 GWV 没有收到治疗建议 78% 的人对他们的护理不太满意。缩小这种质量差距至关重要。弗吉尼亚州 和国防部已投资数亿美元开发新疗法，包括第二大疗法 GWV 临床试验发现健康指导和解决问题的治疗均可减少残疾 GWI 的。如果没有有效的医疗保健模式来实施这些治疗，GWV 将不会受益。在 目前的护理模式，GWV 通过 VA 的初级护理患者协调护理团队在当地接受护理 （协议）。退伍军人管理局战争相关疾病和伤害研究中心 (WRIISC) 通过以下方式支持当前的护理模式： 通过国民教育增加当地对管理 GWI 所需的技能和治疗的了解 对疑难案件进行电子咨询（e-consulting）。 WIISC 和其他利益相关者 目前质疑提高当地对 GWI 的技能和治疗知识是否足以解决 质量差距，或者如果 GWI 太复杂而无法在没有来自其他机构的额外支持的情况下在初级保健中进行治疗 GWI 专家。 GWI 的一种潜在有用的护理模式是协作专业护理，其中专家 与 PACT 合作，协同治疗患者。当地 PACT 是专家团队的领导 向患者提供一些直接护理（通过远程医疗），并就其他问题向 PACT 进行咨询 护理方面。协作专科护理对于其他复杂病症（例如抑郁症）有效 超过 40 项研究记录了其功效。该提案的目标是进行混合 1 类随机 GWV 与 GWI 的有效性/实施试验 (n=220)。我们的首要目标是确定 与电子咨询相比，远程 CSC 的有效性。在远程 CSC 中，我们的专业提供商团队将提供 向 GWV 提供健康指导和问题解决治疗，并建议每月进行 PACT 优化镇痛药。在电子咨询中，专业提供商团队将提出一次性推荐 根据 PACT，GWV 在当地接受健康指导和解决问题的治疗和镇痛 优化。我们的次要目标是了解实施结果。该信息将用于 指导未来的随机（VISN）多站点实施研究。自始至终，咨询委员会 将召集运营合作伙伴，确保研究结果能够直接、立即得到 改善护理。确定最佳护理模式，将研究成果转化为具有 GWI 的 GWV 实践是一项艰巨的任务 退伍军人管理局海湾战争战略计划的关键目标以及本申请请求的具体目标。